Joseph Rabin1, Donald G Harris2, Gordon A Crews3, Michelle Ho3, Bradley S Taylor4, Rajabrata Sarkar5, James V O'Connor1, Thomas M Scalea1, Robert S Crawford5. 1. R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. 2. Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: dharris@smail.umaryland.edu. 3. Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 4. Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Center for Aortic Diseases, University of Maryland School of Medicine, Baltimore, Maryland. 5. Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland; Center for Aortic Diseases, University of Maryland School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Blunt thoracic aortic injury (BTAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma, and TBI is common among patients with BTAI. Although aspects of aortic management, such as repair timing and procedural anticoagulation therapy, may complicate TBI, the optimal management of these patients is undefined. METHODS: Adults with BTAI and moderate to severe TBI admitted to a level I trauma center over 12 years were retrospectively analyzed; patients presenting in extremis were excluded. The primary outcome was neurologic progression within 48 hours of aortic repair. Patients undergoing nonoperative aortic management served as controls for baseline TBI progression. Secondary outcomes were aortic morbidity and mortality and overall inpatient survival. RESULTS: Of 309 patients with BTAI, 138 had concurrent TBI, and 75 were included for analysis. Twenty-two (29%) were treated nonoperatively, 29 (39%) had early aortic repair (17 open, 12 endovascular), and 24 (32%) had delayed repair (3 open, 21 endovascular). The severity of TBI was similar between groups. Early aortic repair within 24 hours of admission was independently associated with worsening TBI, regardless of repair modality or anticoagulation use. In contrast, patients undergoing delayed repair had no perioperative neurologic progression despite procedural anticoagulation therapy. Early aortic repair was also associated with increased aortic morbidity and mortality. CONCLUSIONS: For patients with BTAI and TBI, early aortic intervention is associated with progressive TBI regardless of repair modality, as well as increased aortic morbidity and mortality. Patients not requiring emergent intervention can undergo delayed repair with full anticoagulation therapy.
BACKGROUND: Blunt thoracic aortic injury (BTAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma, and TBI is common among patients with BTAI. Although aspects of aortic management, such as repair timing and procedural anticoagulation therapy, may complicate TBI, the optimal management of these patients is undefined. METHODS: Adults with BTAI and moderate to severe TBI admitted to a level I trauma center over 12 years were retrospectively analyzed; patients presenting in extremis were excluded. The primary outcome was neurologic progression within 48 hours of aortic repair. Patients undergoing nonoperative aortic management served as controls for baseline TBI progression. Secondary outcomes were aortic morbidity and mortality and overall inpatient survival. RESULTS: Of 309 patients with BTAI, 138 had concurrent TBI, and 75 were included for analysis. Twenty-two (29%) were treated nonoperatively, 29 (39%) had early aortic repair (17 open, 12 endovascular), and 24 (32%) had delayed repair (3 open, 21 endovascular). The severity of TBI was similar between groups. Early aortic repair within 24 hours of admission was independently associated with worsening TBI, regardless of repair modality or anticoagulation use. In contrast, patients undergoing delayed repair had no perioperative neurologic progression despite procedural anticoagulation therapy. Early aortic repair was also associated with increased aortic morbidity and mortality. CONCLUSIONS: For patients with BTAI and TBI, early aortic intervention is associated with progressive TBI regardless of repair modality, as well as increased aortic morbidity and mortality. Patients not requiring emergent intervention can undergo delayed repair with full anticoagulation therapy.
Authors: Jin Bong Ye; Jin Young Lee; Jin Suk Lee; Se Heon Kim; Hanlim Choi; Yook Kim; Soo Young Yoon; Young Hoon Sul; Jung Hee Choi Journal: Int J Crit Illn Inj Sci Date: 2022-06-24
Authors: Dennis Hundersmarck; Quirine M J van der Vliet; Lotte M Winterink; Luke P H Leenen; Joost A van Herwaarden; Constantijn E V B Hazenberg; Falco Hietbrink Journal: Eur J Trauma Emerg Surg Date: 2020-07-06 Impact factor: 2.374